Dying with Dignity: A Necessary Option

Make no mistake, life is precious. Many wish to live a long, full life surrounded by friends and family. Some are not as fortunate. Although death is inevitable, what is it about this concept that makes it so scary? Perhaps it’s fear of the unknown. Maybe it’s rooted in religious beliefs or the possibility of experiencing pain and suffering. Maybe it’s not having enough time to fulfill goals or say goodbye to loved ones. I bet if you asked people how they would choose to make their final exit, you’d probably hear a similar response to the question. Most people would want to die peacefully at home in their sleep. But what about men and women who face terminal illness? These men and women do not have the luxury of imaging an “ideal” way to die. Their contemplation of death is neither distant nor abstract; their time is limited. They face the sobering reality of knowing they will die in years, months, or days.

On December 20, 2016 District of Columbia Mayor Muriel Bowser signed the D.C. Death with Dignity Act that gives terminally ill D.C. residents the option to end their suffering.[1] Congress has 30 days to oppose the legislation. If the bill remains unopposed, it will become law. Washington D.C. will be the nation’s seventh jurisdiction to allow doctors to prescribe lethal doses of medication to terminally ill residents. The approval of this bill adds support to a controversial practice that is gaining acceptance among the medical community, elected officials, and the public. States that have already legalized physician assisted suicide by statute are Oregon (1997), Washington (2008), Vermont (2013), California (2016), and Colorado (2016). In 2009, Montana’s Supreme Court legalized physician assisted suicide. The D.C. Death with Dignity Act was proposed by D.C. council member Mary M. Cheh. It models Oregon’s Death with Dignity Act and imposes strict limitations and safeguards on the process of choosing to end one’s life.[2]

The D.C. Death with Dignity Act was not without criticism. Some opponents to the D.C. bill object for religious reasons while others believe that doctors helping patients end their lives violates professional ethics. Many are concerned that it will have a disparate impact on persons in lower socioeconomic groups, particularly the black community in Washington D.C.[3] There is fear that discrimination coupled with limited access to medical treatment and preventative care will pressure African Americans to end their lives. Some doubt the bill’s legitimacy altogether and claim that physician assisted suicide is actually intended to reduce government health care costs.[4]

Supporters of the D.C. bill want the end-of-life option available to those who are terminally ill and face extreme pain in the limited time they have left. They believe it provides terminally ill men and women with the ability to choose to end their lives peacefully and with dignity.[5] The aid-in-dying legislation offers men and women some control over otherwise uncontrollable circumstances. A planned death allows them time to say goodbye to loved ones and end their lives in a more positive way. Supporters believe that the legislation is not only compassionate to those who are suffering but also allows the individual agency over his or her own body.

Legislation of this kind is not new. Oregon enacted its Death with Dignity Act in October of 1997. However, aid-in-dying legislation has only recently gained media attention. Publicity surrounding 29-year-old Brittany Maynard’s decision to end her life in 2014 brought awareness to the Death with Dignity movement through Compassion & Choices, an end-of-life advocacy group. Maynard had a progressive form of terminal brain cancer and was given six months to live. She relocated with her family to Oregon to gain access to the state’s Death with Dignity Act. After traveling and advocating for nation-wide end-of-life policy change, Maynard eventually chose to die peacefully at home, surrounded by family.[6] In addition, several national organizations have either endorsed or taken a neutral position on physician assisted aid-in-dying legislation including the American Medical Women’s Association, the American Academy of Hospice & Palliative Medicine, the American Academy of Legal Medicine, the American Medical Student Association, and the American Public Health Association.[7]

In 2013, Pennsylvania resident and nurse, Barbara Mancini, faced criminal charges for allegedly obeying her elderly father’s request to ingest a lethal dose of morphine.[8] The charges were later dismissed in 2014 by a Schuylkill County judge based on hearsay concerns.[9] Barbara Mancini’s story should raise red flags for states that do not provide comprehensive end-of-life options. If terminally ill residents are deprived of their ability to legally choose to end their lives, it places family members in precarious situations. Care takers are forced to either ignore the dying wish of the terminally ill person or face serious legal consequences. Maynard relocated to have the ability to legally choose to end her life, but what about the terminally ill men and who are unable to relocate? It is outrageous to think that these members of our society should even have to consider relocation under such trying circumstances. Without the legalization of physician assisted aid-in-dying, people who choose to end their lives must make this decision without mental evaluation and assistance from physicians. None of the precautionary safeguards incorporated into similar legislation are available to protect them.

Pennsylvania has yet to consider such legislation. In June 2014, a Death with Dignity bill was introduced in Pennsylvania by Senator Daylin Leach of Montgomery County.[10] It has not drawn support and remains in the Judiciary Committee. Leach’s proposal, modeled after Oregon’s law, would allow patients to become eligible for the aid-in-dying option after a mental evaluation and certification that they have less than six months to live from two doctors: one who is treating the patient and one who is not. Pennsylvania state representative Mark Rozzi of Berks County also sponsored a similar bill in April 2015 that remains inactive.[11]

Like Brittany Maynard, my aunt died from brain cancer at the young age of 29. She did not have the ability to make a choice to end her pain and suffering. Although my family remembers her for the vibrant woman she was during her life, they will never forget her rapid decline. The impact of that experience was profound. I do not know whether she would have chosen to end her life, but that is not the point. Providing the terminally ill with the ability to choose is what matters. It is the comfort of having end-of-life options that is important.